A nationwide survey of truncal gunshot wounds identified 119 patients managed in 34 institutions.The wounds resulted from low-velocity bullets in 69%, high-velocity bullets in 6%, and shotgun pellets in 25%. The thoracic or abdominal cavity was penetrated in 62%, and the mean Injury Severity Score was 16 (range, 1 to 57). The wounding capacity of close-range shotgun pellets equaled that of high-velocity bullets, whereas long-range (>10 meters) shotgun injuries resembled air rifle injuries in their poor ability to penetrate deeper structures and cause internal injuries. A thoracotomy or sternotomy was required in 31% of the penetrating thoracic injuries. Of 57 laparotomies, 9% were negative. In four cases (7% of all laparotomies), a significant abdominal organ injury was overlooked at the initial operation, emphasizing the importance of meticulous exploration of all abdominal organs, and especially the diaphragm and the retroperitoneal structures.